Associations between Parental Perceptions of the Neighbourhood Environment and Childhood Physical Activity: Results from ISCOLE-Kenya

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ORIGINAL RESEARCH Journal of Physical Activity and Health, 2016, 13, 333 -343

http://dx.doi.org/10.1123/jpah.2014-0595 © 2016 Human Kinetics, Inc.

Muthuri (smuthuri@hotmail.com) is with the Population Dynamics and Reproductive Health Program, African Population and Health Research Center, Nairobi, Kenya. Wachira is with the Dept of Physical and Health Education, Kenyatta University, Nairobi, Kenya. Onywera and Tremblay are with the Dept of Recreation Management and Exercise Science, Kenyatta University, Nairobi, Kenya, and the Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.

Associations Between Parental Perceptions

of the Neighborhood Environment and Childhood

Physical Activity: Results from ISCOLE-Kenya

Stella K. Muthuri, Lucy-Joy M. Wachira, Vincent O. Onywera, and Mark S. Tremblay

Background: A physical activity transition to declining activity levels, even among children, now poses a serious public health concern because of its contribution to a rising prevalence of noncommunicable diseases. Childhood physical activity levels are associated with parental percep-tions of the neighborhood; however, these relapercep-tionships have not been explored in sub-Saharan Africa (SSA). The objective was to investigate relationships between parental perceptions of the neighborhood and physical activity indicators among Kenyan children. Methods: Data were collected from children 9 to 11 years old in Nairobi as part of the International Study of Childhood Obesity, Lifestyle and Environment. Child physical activity was assessed by accelerometry, and information on obtaining sufficient physical activity, active transport, and parental perceptions of the neighborhood collected using questionnaires. Results: Of 563 participating children, 45.7%, 12.6%, and 11.4% used active school transportation, met physical activity guidelines, and were sufficiently active, respectively. Parental perception of positive neighborhood social cohesion, positive environs and connectivity, and negative child safety concerns, were associated with child physical activity outcomes. Conclusions: Aspects of parental perceptions of the neighborhood were associated with child physical activity outcomes and should be further explored to appropriately inform policy and practice in curbing declining physical activity levels among children in SSA.

Keywords: father and mother opinions, built environment, social surroundings, child, movement

Although the health benefits of maintaining an active lifestyle are well known, research has shown that a physical activity transi-tion, described as declining physical activity levels, now poses a growing public health burden globally.1 This has ultimately led to a rising prevalence of noncommunicable diseases, including heart disease, diabetes, hypertension, and certain forms of cancer, around the world.2 Children and youth, who have also not been spared from the effects of such behavioral transitions, are particularly disadvan-taged because of the potential for lifelong ill-health consequences.3 It has been suggested that advances in the measurement of physi-cal activity at home, work, and for transport, in a wide variety of populations will be integral to advancing the understanding of how these behavioral transitions shape physical activity patterns.1 Many children spend much of their time in and around their immediate neighborhoods, and parental perceptions of the neighborhood environment are correlated with various aspects of children’s activ-ity.4 Indeed, the associations between parental perceptions of the neighborhood environment and active transportation or physical activity among children have been investigated in several higher income countries5–9; however, these relationships have been largely overlooked in studies conducted in developing countries, particu-larly within sub-Saharan Africa (SSA).10

Systematic review evidence reveals that active transportation, particularly to and from school, is associated with increases in physical activity and cardiovascular fitness.11 Children who walk or

cycle to school have higher daily levels of physical activity and are more likely to meet physical activity guidelines than children who use motorized transport, and these effects are noted with both self-report and objective measures of physical activity.11–13 Children’s active transportation and physical activity levels are also associated with parental perceptions of the neighborhood physical and social environment.14 Active transportation among children is positively associated with parental active transportation to work and other locations.7 Older children are more likely to use active transportation than their younger counterparts due to lower parental safety concerns and a reduced need for parental supervision,7 although children of all ages are more likely to use active transportation if the distance from home to school is shorter and the route is easily accessible.6,9,15,16 Higher levels of parental perceived social safety (eg, child-friendly communities), social cohesion, and traffic safety are also positively associated with active transportation among children.5,7–9 Children whose parents know many people in their neighborhood and who are satisfied with the number of pedestrian crossings are more likely to increase their active transportation, whereas children with parents perceiving that there are insufficient traffic lights and pedestrian crossings in the neighborhood are less likely to increase their active transportation.17 More generally, parents perceiving shorter distances to school, higher residential density, higher neighborhood aesthetics, more land-use-mix diversity, availability of adequate walking/cycling infrastructure, proximity to recreational facilities, and more safety from traffic and crime have been associated with higher total childhood physical activity.4,15

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334 Muthuri et al

low crime rate at night, interesting things to look at, and seeing many people active were significantly associated with sufficient walking.18 In a different study on Nigerian adolescents, access to destinations was positively associated with active transportation to school; more generally, however, few environmental attributes were associated with physical activity among the adolescents.19 Among Nigerian adults, perceived safety from crime and traffic were positively associated with physical activity.10 These indiscriminate patterns may be emerging evidence that environmental correlates of physical activity conducted in higher income countries may not be generalizable to Africa.

Given that emerging evidence of a physical activity transition among school-aged children has also been observed in countries within SSA,20–22 it is crucial that reliable and culturally sensitive measures of the neighborhood built and social environment, and assessment of environmental perceptions related to physical activity, be developed to accurately capture the correlates of physical activ-ity among children in low-income countries.23,24 This will require efforts in adapting neighborhood monitoring tools for the African context, allowing data collection to better inform evidence-based policies and programs for the reversal of declines in children’s physical activity and active transportation, and promotion of healthy active lifestyles. Consequently, the purpose of this work was to explore the associations between parental perceptions of the neighborhood physical and social environment and children’s self-reported and directly measured physical activity and active school transportation in Kenya.

Methods

The ISCOLE Project

The International Study of Childhood Obesity, Lifestyle and Envi-ronment (ISCOLE) project was designed to investigate the influence of behavioral settings and the physical, social, and policy environ-ments on the observed relationship between lifestyle and weight status among school-aged children from 12 countries around the world.25 Although previous multicountry childhood obesity stud-ies have focused on specific geographic regions (eg, Europe), this study was designed to have global representation, including both developing and developed countries. The study design also incor-porated comprehensive and robust indicators of lifestyle behaviors (eg, physical activity, food consumption, sedentary behavior, and sleep) and directly measured adiposity and physical activity. More details on the ISCOLE study protocol are provided elsewhere.25 In Kenya, data collection was conducted in Nairobi after ethical approval from Kenyatta University Ethics Review Committee (the local organizing institution), the Nairobi City Council, and the National Council for Science and Technology.26

ISCOLE-Kenya Study Design

A sex-balanced sample of approximately 500 children was conve-niently recruited from nonboarding public (lower socioeconomic status [SES]) and private (higher SES) primary schools in Nairobi. In these schools, classrooms with the highest number of children about 10 years old were then sampled. Typically, 30 to 50 children per school were invited to participate and were sent home with infor-mation on the study along with a consent form for their parent(s)/ guardian(s) to review and sign. Children were also asked to provide assent to participate in the study. Physical activity of the participat-ing children was directly measured usparticipat-ing accelerometry, and they

completed a questionnaire related to their diet and lifestyle. School administrators and parent(s)/guardian(s) of participating children also completed questionnaires on the school and neighborhood environments. Data collection was conducted for a full school year in 2012, excluding the month-long holiday breaks in April, August, and December.

Accelerometry

Physical activity of the participating children was directly mea-sured using accelerometers (GT3X+; ActiGraph, Pensacola, FL) at a 1-second epoch setting. Accelerometers were attached firmly to belts, and appropriate wearing of the devices on the right side of the waist was demonstrated to the children by the research team. Participating children were instructed to wear the devices 24 hours per day for at least 7 consecutive days (at all times except when bathing or swimming), including an initial familiarization day, maximizing the number of children providing at least 4 days of wear of 10 hours or more, with at least one valid weekend day. Nonwear time within a day was classified as 60 consecutive minutes of 0 counts.25 Reminders to children from class teachers and reminder calls to their parent(s)/guardian(s) were helpful in ensuring that children wore and returned the devices as required. Data from the accelerometers were downloaded and reviewed for completeness, and data reduction was conducted using cut-points validated in children and youth; moderate-to-vigorous physical activity (MVPA) was classified as ≥ 3000 counts per minute.27 We then calculated the number of children meeting the World Health Organization (WHO) physical activity guidelines of at least 60 minutes of MVPA daily.28

Questionnaires

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Parental Opinion of Neighborhood and Child Activity 335

to ensure maximal external validity, and provisions were made to administer the questionnaire via an interview for participants with low levels of literacy. In few cases, regional and cultural variation necessitated further adaptations of some of the items and exam-ples. Intercountry variability of the reliability and validity of the adapted questionnaires is possible given the scale of the ISCOLE project.

Statistical Analysis

The statistical analyses presented in this article were computed using SAS (version 9.3; SAS Institute, Cary, NC). Sample sizes and percentages of child-level and parental-level factors, including parental perceptions of the neighborhood environment, are reported in Table 1. Univariable analysis was used to investigate associations between parental perceptions of the neighborhood environment and child active school transportation (self-reported), sufficient activ-ity levels (self-reported), and meeting MVPA guidelines (directly measured) as reported in Table 2. Multivariable modeling using a forward selection approach was completed using variables that were significantly associated with child physical activity outcomes but yielded no significant results.

Results

Participant and Parent Characteristics

As shown in Table 1, a total of 563 participants (53.5% girls), 9.0 to 11.9 years of age, were included in the analyses. Less than half of the children (45.7%) reported that they used active transporta-tion (eg, walking, running) to/from school. Sixty-four children (11.4%) reported being sufficiently active (physically active for at least 60 minutes on 6 to 7 days during the past week), and 71 children (12.6%) met the MVPA guideline of ≥ 60 minutes of directly measured daily MVPA. A higher percentage of moth-ers (16.3%) than fathmoth-ers (8.4%) of the participating children had a primary or lower education level, and only 12.0% of mothers had a graduate or professional degree, whereas this percentage was 21.9% among fathers.

Parental Perceptions of the Neighborhood Environment

Assessment of parental perceptions of the neighborhood environ-ment revealed that over half of the parents agreed that people in their neighborhood were willing to help their neighbors (60.7%) and could be trusted (54.5%). When asked about the ease of getting around in the neighborhood, a large percentage (85.2%) indicated that shopping areas were within easy walking distance, whereas slightly fewer respondents agreed that that there was a transit stop (76.6%) and many places to go within easy walking dis-tance of their home (60.9%). A total of 247 (45.2%) agreed that the speed of traffic on most streets was usually slow, yet 65.1% indicated that most drivers go faster than the posted speed limits and 48.0% reported that the traffic makes it difficult for their children to walk. When asked about fear of their children being taken or hurt by a stranger, 72.8% of parents indicated that this was a danger on local streets; 49.3% that this was a danger in their yard, driveway, or common area; and 65.4% that this was a danger in a local park. A total of 304 respondents (55.6%) reported that they were afraid of their child being taken or hurt by a known bad person in the neighborhood.

Parental Perceptions of the Neighborhood Associated With Childhood Physical Activity

It is noteworthy that the analyses included in Table 2 are pooled data (n = 380), combining public and private school children. However, analysis of public (n = 269) and private (n = 111) school children separately showed that in private schools, there were largely no significant findings (see Tables 3 and 4). This is possibly due to the lower sample size. The sole significant finding was parents’ fear of their child being taken or hurt by a stranger in a local park was associated with children’s report of being sufficiently active. Consequently, the significant findings in these pooled analyses are largely driven by public school children. Univariable analysis showed that parents’ perception that people in their neighborhood could be trusted was positively associated with child active trans-portation and meeting MVPA guidelines; that is, 49.0% and 43.7% of the total number of children who used active transportation or who met MVPA guidelines, respectively, had parents who agreed that people in their neighborhood could be trusted. There was a positive association between (1) parents reporting that there was a transit stop within walking distance from their home, that there were not many dead-end streets in their neighborhood, that there were crosswalks and signals on busy streets and (2) children using active transportation or meeting MVPA guidelines. There was also a positive association between (1) parents’ agreement that streets had good lighting at night and that there were many places to go within easy walking distance of their home and (2) child active transportation. Parents’ report that there were many different routes for getting from place to place was positively associated with child self-reported sufficient activity. Finally, parents’ indication that they were afraid of their child being taken or hurt by a known bad person in their neighborhood was positively associated with child active transportation, whereas parents’ fear of their child being taken or hurt by a stranger on local streets or in a local park was positively associated with child self-reported sufficient activity. There were no significant results in multivariable analyses using variables that were significantly associated with child physical activity outcomes in univariable analysis.

Discussion

The results from this study revealed significant associations between various aspects of parental perceptions of the neighborhood physical and social environment, and child self-reported active transportation, self-reported sufficient activity, and meeting the MVPA guidelines.

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Table 1 Descriptive Characteristics of Participating Children, Parents, and Parental Perceptions of the Neighborhood Environment

Characteristic n (%)

Child factors Sex

Boys 262 (46.5)

Girls 301 (53.5)

Attendance by type of school

Public (lower SES) 295 (52.4)

Private (higher SES) 268 (47.6)

Transport to school—self-reported

Active (walking, bicycle, roller blade, skate board) 245 (45.7)

Motorized (bus, van, car) 291 (54.3)

Days child was physical active for at least 60 minutes—self-reported

0–5 days (insufficiently active) 499 (88.6)

6–7 days (sufficiently active) 64 (11.4)

Met MVPA guidelines (mean of ≥60 minutes of daily MVPA)—directly measured 71 (12.6)

Parental factors

Maternal education level

Primary or less 91 (16.3)

High school or less 163 (29.2)

Diploma/higher diploma/degree 237 (42.5)

Graduate/professional degree 67 (12.0)

Paternal education level

Primary or less 43 (8.4)

High school or less 159 (31.1)

Diploma/higher diploma/degree 197 (38.6)

Graduate/professional degree 112 (21.9)

Parental perceptions of the neighborhood environmenta

People around my neighborhood are willing to help their neighbors. 336 (60.7)

People in my neighborhood can be trusted 301 (54.5)

There are shops, stores, markets, and places to buy things I need within easy walking distance of my home/house. 467 (85.2)

There is a bus, transit/stage, or train stop within walking distance from my home 420 (76.6)

There are sidewalks on most streets. 366 (66.9)

There are NOT many dead end streets. 347 (64.0)

There are many different routes for getting from place to place. 422 (77.4)

There is a high crime rate. 232 (42.5)

The speed of traffic on most streets is usually slow (30 mph or less). 247 (45.2)

Most drivers go faster than the posted speed limits. 355 (65.1)

There are many interesting things to look at while walking in my neighborhood. 319 (58.3)

The traffic makes it difficult or unpleasant for my child to walk. 263 (48.0)

Streets have good lighting at night. 258 (47.1)

There are crosswalks and signals on busy streets. 184 (33.7)

There are many places to go within easy walking distance of my home. 332 (60.9)

I’m afraid of my child being taken or hurt by a stranger on local streets. 399 (72.8)

I’m afraid of my child being taken or hurt by a stranger in my yard, driveway, or common area. 270 (49.3)

I’m afraid of my child being taken or hurt by a stranger in a local park. 357 (65.4)

I’m afraid of my child being taken or hurt by a known “bad” person (adult or child) in my neighborhood. 304 (55.6)

Abbreviations: SES, socioeconomic status; MVPA, moderate-to-vigorous physical activity.

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Tab le 2 A ssociations Betw een P ar ental P er

ceptions of the Neighbor

hood En

vir

onment and Childhood Ph

ysical A ctivity Stat ement Child Self-R epor t of A ctiv e T ranspor tation

(n = 245)

Child Self-R

epor

t of Being

Suf

ficientl

y A

ctiv

e

(n = 64)

Child Dir ectl y Measur ed Met MVP A Guidelines

(n = 71)

n (%) P n (%) P n (%) P

People around my neighborhood are willing to help their neighbors.

134 (55.6) .0502 43 (68.3) .1894 37 (52.1) .1148

People in my neighborhood can be trusted.

118 (49.0)* .0406 40 (63.5) .1290 31 (43.7)* .0488

There are shops, stores, mark

ets, and places to b

uy things I need within easy w

alking distance of my

home/house. 207 (87.0) .4139 55 (88.7) .4109 61 (87.1) .6272

There is a b

us, transit/stage, or train stop within w

alking distance from my home

171 (71.9)* .0109 48 (77.4) .8780 42 (60.0)* .0004

There are side

w

alks on most streets.

160 (67.0) .7896 44 (72.1) .3579 45 (64.3) .6172

There are NO

T man

y dead end streets.

137 (58.1)* .0287 39 (66.1) .7244 34 (48.6)* .0039

There are man

y dif

ferent routes for getting from place to place.

190 (80.2) .0985 54 (88.5)* .0279 58 (82.9) .2447

There is a high crime rate.

107 (45.2) .3165 28 (45.2) .6514 33 (47.1) .3991

The speed of traffic on most streets is usually slo

w (30 mph or less).

111 (46.8) .6819 27 (44.3) .8709 30 (42.9) .6682 Most dri

vers go f

aster than the posted speed limits.

154 (65.3) .9989 36 (59.0) .2871 48 (68.6) .5184

There are man

y interesting things to look at while w

alking in my neighborhood.

146 (61.3) .2875 33 (53.2) .3878 38 (54.3) .4637

The traffic mak

es it difficult or unpleasant for my child to w

alk. 113 (47.3) .7670 30 (48.4) .9474 36 (51.4) .5378 Streets ha

ve good lighting at night.

123 (51.7)* .0345 24 (38.7) .1609 36 (51.4) .4352

There are crossw

alks and signals on b

usy streets. 98 (41.2)* .0013 14 (23.0) .0595 31 (44.3)* .0448

There are man

y places to go within easy w

alking distance of my home.

157 (66.0)* .0281 32 (51.6) .1248 48 (68.6) .1431

I’m afraid of my child being tak

en or hurt by a stranger on local streets.

172 (72.0) .7134 53 (85.5)* .0172 52 (74.3) .7664

I’m afraid of my child being tak

en or hurt by a stranger in my yard, dri

ve

w

ay

, or common area.

122 (51.1) .8119 37 (59.7) .0818 42 (60.0) .0545

I’m afraid of my child being tak

en or hurt by a stranger in a local park.

152 (63.9) .7012 48 (78.7)* .0205 48 (68.6) .5483

I’m afraid of my child being tak

en or hurt by a kno

wn “bad” person (adult or child) in my

neighborhood. 144 (60.5)* .0458 41 (66.1) .0757 42 (60.0) .4250 Note

. The percentages reported are for respondents who agree or strongly agree with the statements. c

2 test results reported (all associations reported are positi

ve). Percentages may e

xclude missing parental le

vel data.

Abbre

viations: MVP

A, moderate-to-vigorous ph

ysical acti

vity

.

*P

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Tab le 3 A ssociations Betw een P ar ental P er

ceptions of the Neighbor

hood En

vir

onment and Childhood Ph

ysical A ctivity (P ub lic Sc hools) Stat ement Child Self-R epor t of A ctiv e T ranspor tation

(n = 1

65) Child Self-R epor t of Being Suf ficientl y A ctiv e

(n = 35)

Child Dir ectl y Measur ed Met MVP A Guidelines

(n = 69)

n (%) P n (%) P n (%) P

People around my neighborhood are willing to help their neighbors.

84 (51.8) .1923 20 (58.8) .7149 36 (52.2) .4744

People in my neighborhood can be trusted.

77 (47.5) .7430 21 (61.8) .1067 30 (43.5) .3120

There are shops, stores, mark

ets, and places to b

uy things I need within easy w

alking distance of my

home/house. 135 (84.4) .5057 31 (91.2) .3209 59 (86.8) .7465

There are NO

T man

y dead end streets.

86 (53.4) .1902 20 (58.8) .9625 32 (47.1) .0344

There are man

y dif

ferent routes for getting from place to place.

125 (78.1) .1774 31 (91.2) .0309 56 (82.3) .1630

There is a high crime rate.

85 (53.4) .3184 20 (58.8) .3025 33 (48.5) .7050

The speed of traffic on most streets is usually slo

w (30 mph or less).

79 (49.4) .4760 13 (39.4) .3518 29 (42.6) .4097 Most dri

vers go f

aster than the posted speed limits.

96 (60.4) .5888 18 (52.9) .2550 48 (70.6) .0883

There are man

y interesting things to look at while w

alking in my neighborhood.

101 (63.13) .0639 17 (50.0) .3077 37 (54.4) .4798

The traffic mak

es it difficult or unpleasant for my child to w

alk. 76 (47.2) .2353 15 (44.1) .4516 34 (50.0) .9735 Streets ha

ve good lighting at night.

91 (56.9) .0259 13 (38.2) .1109 35 (51.5) .9375

There are crossw

alks and signals on b

usy streets. 75 (46.9) .0331 10 (29.4) .1483 31 (45.6) .3616

There are man

y places to go within easy w

alking distance of my home.

106 (65.8) .2583 17 (50.0) .1100 47 (69.1) .1936

I’m afraid of my child being tak

en or hurt by a stranger on local streets.

115 (71.4) .8888 28 (82.3) .1460 50 (73.5) .7211

I’m afraid of my child being tak

en or hurt by a stranger in my yard, dri

ve

w

ay

, or common area.

94 (58.4) .5309 24 (70.6) .0528 41 (60.3) .3226

I’m afraid of my child being tak

en or hurt by a stranger in a local park.

102 (63.4) .8411 25 (73.5) .2271 47 (69.1) .3334

I’m afraid of my child being tak

en or hurt by a kno

wn “bad” person (adult or child) in my

neighborhood. 100 (62.1) .2731 25 (73.5) .0788 41 (60.3) .9011

There is a b

us, transit/stage, or train stop within w

alking distance from my home

102 (63.7) .0044 26 (76.5) .4636 41 (60.3) .0313

There are side

w

alks on most streets.

106 (65.8) .6686 25 (73.5) .2934 43 (63.2) .6534 Note

. The percentages

reported

are for

respondents who

agree or strongly

agree with

the statements.

c

2 test

results reported (all

associations

reported are

positi

ve). Percentages

may e

xclude missing parental

le

vel data.

Abbre

viations: MVP

A, moderate-to-vigorous ph

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Tab le 4 A ssociations Betw een P ar ental P er

ceptions of the Neighbor

hood En

vir

onment and Childhood Ph

ysical A ctivity (P riv at e Sc hools) Stat ement Child Self-R epor t of A ctiv e T ranspor tation

(n = 80)

Child Self-R epor t of Being Suf ficientl y A ctiv e

(n = 29)

Child Dir

ectl

y Measur

ed

Met MVP

A Guidelines (n = 2)

n (%) P n (%) P n (%) P

People around my neighborhood are willing to help their neighbors.

50 (63.3) .6004 23 (79.3) .1040 1 (50.0) .6366

People in my neighborhood can be trusted.

41 (51.9) .0890 19 (65.5) .5778 1 (50.0) .7545

There are shops, stores, mark

ets, and places to b

uy things I need within easy w

alking distance of my

home/house. 72 (92.3) .0515 24 (85.7) .8925 2 (100.0) .5486

There are NO

T man

y dead end streets.

51 (68.0) .6164 19 (76.0) .5015 2 (100.0) .3544

There are man

y dif

ferent routes for getting from place to place.

65 (84.4) .1358 23 (85.2) .3997 2 (100.0) .4632

There is a high crime rate.

22 (28.2) .1927 8 (28.6) .5331 0 (0) .3100

The speed of traffic on most streets is usually slo

w (30 mph or less).

32 (41.6) .6039 14 (50.0) .4523 1 (50.0) .8488 Most dri

vers go f

aster than the posted speed limits.

58 (75.3) .1535 18 (66.7) .8097 0 (0) .0954

There are man

y interesting things to look at while w

alking in my neighborhood.

45 (57.7) .7439 16 (57.1) .8725 1 (50.0) .8053

The traffic mak

es it difficult or unpleasant for my child to w

alk. 37 (47.4) .6947 15 (53.6) .3720 2 (100.0) .1212 Streets ha

ve good lighting at night.

32 (41.0) .8618 11 (39.3) .6907 1 (50.0) .8364

There are crossw

alks and signals on b

usy streets. 23 (29.5) .3560 4 (14.8) .1633 0 (0) .4006

There are man

y places to go within easy w

alking distance of my home.

51 (66.2) .0936 15 (53.6) .5712 1 (50.0) .8053

I’m afraid of my child being tak

en or hurt by a stranger on local streets.

57 (73.1) .7280 25 (89.3) .0667 2 (100.0) .3984

I’m afraid of my child being tak

en or hurt by a stranger in my yard, dri

ve

w

ay

, or common area.

28 (35.9) .0982 13 (46.4) .6954 1 (50.0) .8401

I’m afraid of my child being tak

en or hurt by a stranger in a local park.

50 (64.9) .8602 23 (85.2) .0320 1 (50.0) .6157

I’m afraid of my child being tak

en or hurt by a kno

wn “bad” person (adult or child) in my

neighborhood. 44 (57.1) .2596 16 (57.1) .5017 1 (50.0) .9741

There is a b

us, transit/stage, or train stop within w

alking distance from my home

69 (88.5) .2012 22 (78.6) .5546 1 (50.0) .2228

There are side

w

alks on most streets.

54 (69.2) .7788 19 (70.4) .8199 2 (100.0) .3350 Note

. The percentages reported are for respondents who agree or strongly agree with the statements. c

2 test results reported (all associations reported are positi

ve). Percentages may e

xclude missing parental le

vel data.

Abbre

viations: MVP

A, moderate-to-vigorous ph

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342 Muthuri et al

driven by those in public school, their lower SES may limit their access to and use of motorized transport.

These results closely matched associations found between aspects of parental perceptions of the neighborhood and the percent-age of children meeting MVPA guidelines. Parental perception of positive neighborhood social cohesion (that people in their neighbor-hood could be trusted) and positive neighborneighbor-hood physical environs and connectivity (that there was a bus or transit stage/stop within walking distance of the home, that there were not many dead end streets, and that there were crosswalks and signals on busy streets) were associated with children meeting MVPA guidelines. Closely aligned results for factors associated with active transportation and meeting MVPA guidelines may be supported by previous work showing that children who use active transportation are more likely to accumulate higher MVPA levels and/or meet MVPA guidelines, even in the Kenyan context.11–13,26 Further, these findings provide emerging evidence that children’s active transportation and physi-cal activity levels are associated with parental perceptions of the neighborhood environment, similar to previous findings from studies conducted in higher income countries, particularly related to per-ceived safety and social cohesion, ease of getting around because of shorter distance and route accessibility, adequate pedestrian crossings, and sufficient traffic lights.4–9,14–17

A small percentage of children reported that they were suf-ficiently active on at least 6 to 7 days during the week. Parental perception of positive neighborhood connectivity (that there were many different routes of getting from place to place) and negative child safety concerns (fear of their children being taken or hurt by a stranger on local streets and fear of their children being taken or hurt by a stranger in a local park) were associated with children being sufficiently active. The parental perception factors that were significantly associated with self-reported sufficient activity were different from those related to active transportation and meeting MVPA guidelines; however, weak correlations between self-reported and directly measured physical activity have previously been found in this setting.29

There were no significant results in multivariable modeling using variables that were significantly associated with child physi-cal activity outcomes because of high collinearity between parental perceptions of the neighborhood environment variables (ie, a high likelihood that a large percentage of parents were responding very similarly to questions on their perceptions of the environment). This research study has several limitations, including a cross-sectional design, with all of the inherent weaknesses. The sampling was non-representative; rather, it was designed to capture sampling variation in socioeconomic status, which may limit the generalizability of the findings. Finally, self-reported information introduces several response biases. The study does, however, have several strengths, including robust objective measures of anthropometric data and accelerometry from children, rigorous training of the research team, and quality control. The study therefore provides an excellent opportunity to increase our understanding of the correlates of child physical activity patterns.

Conclusion

In summary, parental perception of positive neighborhood social cohesion was associated with child active transportation (self-reported) and meeting MVPA guidelines (directly measured); parental perception of positive neighborhood physical environs and connectivity was associated with active transportation, meet-ing MVPA guidelines, and sufficient activity (self-reported); and

parental perception of negative child safety concerns was associated with active transportation and sufficient activity among children. These results are largely driven by public school (lower SES) children, pointing to an SES difference in parental perceptions of the neighborhood and, consequently, physical activity patterns among their children. The findings provide preliminary evidence of, and highlight the need for, further investigation into parental perceptions of the neighborhood physical and social factors that may affect physical activity of school-aged children in the African context.

Acknowledgments

We are grateful to all the students and families who participated in the ISCOLE-Kenya study and the research assistants who helped with data collection and entry. We thank the ISCOLE Coordinating Center staff at the Pennington Biomedical Research Center for study coordination and data management (Peter T. Katzmarzyk, PhD, and Timothy S. Church, MD, principal investigators, and Denise Lambert, project manager). We would also like to recognize principal investigators from the 12 participating countries who played a role in developing the research study design and protocol. ISCOLE is funded by the Coca-Cola Company. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References

1. Katzmarzyk PT, Mason C. The physical activity transition. J Phys Act

Health. 2009;6:269–280. PubMed

2. World Health Organization. Global Health Risks: Mortality and

Burden of Disease Attributable to Selected Major Risks. Geneva, Switzerland: World Health Organization; 2009.

3. United States Department of Health and Human Services.

Physi-cal Activity Guidelines Advisory Committee Report. Washington, DC: United States Department of Health and Human Services; 2008.

4. Tappe KA, Glanz K, Sallis JF, Zhou C, Saelens BE. Children’s physi-cal activity and parents’ perception of the neighborhood environment: neighborhood impact on kids study. Int J Behav Nutr Phys Act. 2013;10:39 doi:10.1186/1479-5868-10-39. PubMed

5. Aarts MJ, Mathijssen JJ, van Oers JA, Schuit AJ. Associations between environmental characteristics and active commuting to school among children: a cross-sectional study. Int J Behav Med. 2013;20:538–555. PubMed doi:10.1007/s12529-012-9271-0

6. D’Haese S, De Meester F, De Bourdeaudhuij I, Deforche B, Cardon G. Criterion distances and environmental correlates of active com-muting to school in children. Int J Behav Nutr Phys Act. 2011;8:88 doi:10.1186/1479-5868-8-88. PubMed

7. Henne HM, Tandon PS, Frank LD, Saelens BE. Parental factors in chil-dren’s active transport to school. Public Health. 2014;128:643–646. PubMed doi:10.1016/j.puhe.2014.05.004

8. McDonald NC, Deakin E, Aalborg AE. Influence of the social environment on children’s school travel. Prev Med. 2010;50(Suppl 1):S65–S68. PubMed doi:10.1016/j.ypmed.2009.08.016

9. Timperio A, Ball K, Salmon J, et al. Personal, family, social, and environmental correlates of active commuting to school. Am J Prev

Med. 2006;30:45–51. PubMed doi:10.1016/j.amepre.2005.08.047

10. Oyeyemi AL, Adegoke BO, Sallis JF, Oyeyemi AY, De Bourde-audhuij I. Perceived crime and traffic safety is related to physical activity among adults in Nigeria. BMC Public Health. 2012;12:294 doi:10.1186/1471-2458-12-294. PubMed

(11)

Parental Opinion of Neighborhood and Child Activity 343

12. Davison KK, Werder JL, Lawson CT. Children’s active commuting to school: current knowledge and future directions. Prev Chronic Dis. 2008;5:A100. PubMed

13. Lee MC, Orenstein MR, Richardson MJ. Systematic review of active commuting to school and children’s physical activity and weight. J

Phys Act Health. 2008;5:930–949. PubMed

14. Franzini L, Elliott MN, Cuccaro P, et al. Influences of physical and social neighborhood environments on children’s physical activity and obesity. Am J Public Health. 2009;99:271–278. PubMed doi:10.2105/ AJPH.2007.128702

15. De Meester F, Van Dyck D, De Bourdeaudhuij I, Cardon G. Parental perceived neighborhood attributes: associations with active transport and physical activity among 10–12 year old children and the mediat-ing role of independent mobility. BMC Public Health. 2014;14:631. doi:10.1186/1471-2458-14-631. PubMed

16. Chillón P, Panter J, Corder K, Jones AP, Van Sluijs EM. A longitudinal study of the distance that young people walk to school. Health Place. 2015;31:133–137 doi:10.1016/j.healthplace.2014.10.013. PubMed 17. Hume C, Timperio A, Salmon J, Carver A, Giles-Corti B, Crawford

D. Walking and cycling to school: predictors of increases among children and adolescents. Am J Prev Med. 2009;36:195–200. PubMed doi:10.1016/j.amepre.2008.10.011

18. Oyeyemi AL, Adegoke BO, Oyeyemi AY, Sallis JF. Perceived envi-ronmental correlates of physical activity and walking in African young adults. Am J Health Promot. 2011;25(5):e10–e19. PubMed doi:10.4278/ajhp.090918-QUAN-304

19. Oyeyemi AL, Ishaku CM, Deforche B, Oyeyemi AY, De Bourdeaud-huij I, Van Dyck D. Perception of built environmental factors and physical activity among adolescents in Nigeria. Int J Behav Nutr Phys

Act. 2014;11:56 doi:10.1186/1479-5868-11-56. PubMed

20. Larouche R, Oyeyemi AL, Prista A, Onywera V, Akinroye KK, Trem-blay MS. A systematic review of active transportation research in Africa and the psychometric properties of measurement tools for chil-dren and youth. Int J Behav Nutr Phys Act. 2014;11:129 doi:10.1186/ s12966-014-0129-5. PubMed

21. Onywera VO. Childhood obesity and physical inactivity threat in Africa: strategies for a healthy future. Glob Health Promot. 2010;17(2 Suppl):45–46. PubMed doi:10.1177/1757975910363937

22. Onywera VO, Adamo KB, Sheel AW, Waudo JN, Boit MK, Tremblay M. Emerging evidence of the physical activity transition in Kenya. J

Phys Act Health. 2012;9:554–562. PubMed

23. Oyeyemi AL, Sallis JF, Deforche B, Oyeyemi AY, De Bourdeaudhuij I, Van Dyck D. Evaluation of the neighborhood environment walkability scale in Nigeria. Int J Health Geogr. 2013;12:16 doi:10.1186/1476-072X-12-16. PubMed

24. Oyeyemi AL, Sallis JF, Oyeyemi AY, Amin MM, De Bourdeaudhuij I, Deforche B. Adaptation, test-retest reliability, and construct validity of the Physical Activity Neighbourhood Environment Scale in Nigeria (PANES-N). J Phys Act Health. 2013;10:1079–1090. PubMed 25. Katzmarzyk PT, Barreira TV, Broyles ST, et al. The International

Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE): design and methods. BMC Public Health. 2013;13:900 doi:10.1186/1471-2458-13-900. PubMed

26. Muthuri SK, Wachira LM, Onywera VO, Tremblay MS. Correlates of objectively measured overweight/obesity and physical activity in Kenyan school children: results from ISCOLE-Kenya. BMC Public

Health. 2014;14:436 doi:10.1186/1471-2458-14-436. PubMed 27. Treuth MS, Schmitz K, Catellier DJ, et al. Defining accelerometer

thresholds for activity intensities in adolescent girls. Med Sci Sports

Exerc. 2004;36:1259–1266. PubMed

28. World Health Organization. Global Recommendations on Physical

Activity for Health. Geneva, Switzerland: World Health Organization; 2010.

29. Muthuri SK, Wachira LM, Onywera VO, Tremblay MS. Direct and self-reported measures of physical activity and sedentary behaviours by weight status in school-aged children: results from ISCOLE-Kenya.

Figure

Figure 1 — Self-report questions and the list of possible answers.

Figure 1

— Self-report questions and the list of possible answers. p.4
Figure 1 (Continued)

Figure 1

(Continued) p.5
Table 1 Descriptive Characteristics of Participating Children, Parents, and Parental Perceptions of the Neighborhood Environment

Table 1

Descriptive Characteristics of Participating Children, Parents, and Parental Perceptions of the Neighborhood Environment p.6
Table 2 Associations Between Parental Perceptions of the Neighborhood Environment and Childhood Physical Activity

Table 2

Associations Between Parental Perceptions of the Neighborhood Environment and Childhood Physical Activity p.7
Table 3 Associations Between Parental Perceptions of the Neighborhood Environment and Childhood Physical Activity (Public Schools)

Table 3

Associations Between Parental Perceptions of the Neighborhood Environment and Childhood Physical Activity (Public Schools) p.8
Table 4 Associations Between Parental Perceptions of the Neighborhood Environment and Childhood Physical Activity (Private Schools)

Table 4

Associations Between Parental Perceptions of the Neighborhood Environment and Childhood Physical Activity (Private Schools) p.9